Screening for suicidal behaviour and mental disorders with Prime-MD Questionnaire in general practice

Abstract

Background: The major risk factors for completed suicide are previous suicide attempts and mental disorders. Lifetime prevalence of suicide attempts is 3-4%; and primary care is a major basis for suicide prevention. Aim: To assess the value of a screening method developed to determine the prevalence of suicidal behaviour, and to describe the characteristics of suicide attempters in primary care, including screening for major mental disorders. Methods: A Hungarian urban general practitioner's district with 1248 inhabitants was screened for suicidal behaviour and for major mental disorders. The Prime-MD questionnaire (Primary Care Evaluation of Mental Disorders) was used to recognize the most common psychiatric disorders; suicidal behaviour was assessed by six structured questions of MINI-Plus diagnostic interview. Results: Prevalence of patients with suicide attempts in primary care was 2.9%; 9% of the patients had either suicidal thoughts or gestures the month before. Self-destructive thoughts or behaviour often coexisted with depressive disorders, 60% of suicidal patients and 11.5% of the screened population had depressive episode. According to multivariate logistic regression, suicidal patients were more likely to take antidepressants, they also had a tendency to have more previous psychiatric treatments and suicide attempts; they visited their General Practitioners less frequently and were more likely to have current depressive episodes. Conclusion: The Prime-MD questionnaire, complemented with questions on suicidal behaviour, is an effective, easy-to-use method for general practitioners to assess suicide risk and to recognize the most common mental disorders. This method can be of great help and is proposed for use by general practitioners in every-day practice.